2004, 06-11 Permit App: BLD-04-04597 ResidenceBUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: \ 20(0 C0*\r. l-.\ oN el
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Building Permit
❑ Relocation
II
Change in Use ❑ Grading ❑ Manufactured Home
Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: LIArkcee fq r4 ("Awls "in G
Phone: 47p 1013 Fax: 31013
Address: V 0. zox Pb79z
�po4GavVPr °122
State Zipode
City
Contractor:
Phone:
C/7 n
Fax:-�
Address:
City
State . Zip Code
Applicant:
Phone:
Address:
&Lien 31 -
Fax:
City
❑ Architect:
Phone:
Address:
State Zip Code
Fax:
City
WA State Contractor License #: Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES: \
MAIN FLOOR 10 SSQ�.FTG:
KYI
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: tt i O
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCpO
eYACJ
# OF BEDROOMS: `
TOTAL HABI'TAABBLEiSPACE:
`T
IMPERVIOUS SURFACE AREA:
2?311e
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? ' V.
*ohne
galley
Project Address:
Owner:
Mailing Address:
Contractor:
Mailing Address
19 0 lv Snt-1-1-\
-
\oia
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax. (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
License #:
Phone (Daytime
City
Contact):
State
Phone #:
Asia
Zip Code
AUTHORIZED SIGNATURE
Zip Code
' UItY State -
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
1
X
515.00
=
AMOUNT
2
FUEL BURNING APPLIANCE
More than 100,000
X
519.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
550.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
$100 00
=
5
USED APPLIANCE (WSEC min. AFUE
rating)
Equal to or less than 400,000
X
$50.00
6.
USED APPLIANCE (WSEC min. AFUE
rating)
More than 400,000
X
$700.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$15.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
528.00
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
557.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
59500
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
X
$10.00
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
`
X
$10.00
=
16
MISC FUEL BURNING APPLIANCE
X
$10 00
=
17
GAS PIPING (each outlet)
2
x
stop
=
18
OUCT SYSTEMS
X
$1000
19
VENTILATING FANS
'_t
X
$1000
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
$12.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$19.00
22
EVAPORATIVE COOLERS
X
$10.00
23
TYPE I HOOD
X
$50.00
24
TYPE II HOOD
X
$10.00
25
HEATPUMP/AIR CONDITIONER
0-3 TON
1
X
512.00
=
=
26
AIR CONDITIONER
3-15 TON
X
$20 00
=
27
AIR CONDITIONER
15-30 TON
X
525.00
28
AIR CONDITIONER
30-50 TON
X
535.00
=
=
29
AIR CONDITIONER
More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
$10.00
31
WOOD OR PELLET STOVE/INSERT
X
$1000
=
=
32
WOOD STOVE - FREE STANDING
X
$25.00
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD#.
SUBTOTAL
DATE:
PROCESSING FEE
535.00
EXPIRES.
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE
Zip Code
Spokane
Valley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Project Address: I% hlq i t V ink
Owner: L'rr\
Mailing Address: p• i • RC$ '-I9''?
Contractor:
Mailing Address:
Phone (Daytime Contact):to < q)rOI
1Y V
�Q. StateVl-1G%'e
Ztp Code
License #: Phone #:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
p OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
y
.
X
$6.00
=
2
URINALS
X
$6.00
3
TUBS
2
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
3
X
$6.00
=
6
DISHWASHER
1
X
$6 00
=
7
CLOTHES WASHER
,
X
$6.00
=
8
GARBAGE DISPOSAL
,
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK .
NOTE IF GAS, SEE MECHANICAL
X
$6.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE, _
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
1/43
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
$6-00
=
18
INTERCEPTORS
GREASE TRAP, SANDTRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code